<style>
    .region_city .city-picker-span {
        width: 80% !important;
        position: relative;
    }
</style>
<form class="form-horizontal form-ajax" role="form" data-toggle="validator" method="POST">
    
    <!-- 供应商名称 -->
    <div class="form-group">
        <label for="name" class="control-label col-xs-12 col-sm-2">{:__('SupplierName')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="name" data-rule="required" class="form-control" name="row[name]" placeholder="{:__('SupplierName')}" type="text" value="">
        </div>
    </div>

    <!-- 手机号 -->
    <div class="form-group">
        <label for="mobile" class="control-label col-xs-12 col-sm-2">{:__('Mobile')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="mobile" data-rule="required;" class="form-control" name="row[mobile]" placeholder="{:__('Mobile')}" type="text" value="">
        </div>
    </div>

    <!-- 供应商地区 -->
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Region')}:</label>
        <div class="col-xs-12 col-sm-10 region_city">
            <input id="region" data-toggle="city-picker" name="region" type="text" readonly>
            <!-- 用于提交数据把选中的地区传给后端处理 -->
            <input type="hidden" name="row[code]" id="region-code">
        </div>
    </div>


    <!-- 详细地址 -->
    <div class="form-group">
        <label for="address" class="control-label col-xs-12 col-sm-2">{:__('Address')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="address" data-rule="required;" class="form-control" name="row[address]" placeholder="{:__('Address')}" type="text" value="">
        </div>
    </div>

    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
